Restoring Vision with Quality: WHO’s New Roadmap for Safer, More Effective Cataract Surgery

Cataract is the world's leading cause of blindness. Around 94 million people aged 50 and above are living with vision loss that could be reversed through a relatively simple surgical procedure. Yet for many, especially in low- and middle-income countries, access to safe and high-quality cataract surgery remains uneven.

To address this, the World Health Organization, working with leading institutions such as the WHO Vision and Eye Care Programme, the Dana Centre for Preventive Ophthalmology at Johns Hopkins University's Wilmer Eye Institute, the International Agency for the Prevention of Blindness, the Aravind Eye Care System, the Royal College of Ophthalmologists and the American Academy of Ophthalmology, has released new guidance on improving the quality of cataract surgery services.

In 2021, countries agreed on a bold target: increase effective cataract surgical coverage by 30 percentage points by 2030. The word "effective" is key. It is not enough to perform more surgeries. The surgeries must restore good, functional vision.

Why Quality Matters as Much as Access

Over the past three decades, the number of cataract surgeries performed worldwide has increased. But there is still a significant gap between people who receive surgery and those who regain good vision afterward. WHO findings show that roughly one in three patients does not achieve the expected visual outcome.

This gap often reflects issues that go beyond the operation itself. Poor pre-surgery assessment, infection risks, lack of follow-up care and weak monitoring systems can all affect results. The new recommendations make it clear that improving quality does not always require expensive new technology. In many cases, better training, stronger systems and clearer communication with patients can make a big difference.

Quality care also means being people-centred. Patients should understand what the surgery involves, what risks exist and what results they can realistically expect. Surgery decisions should consider daily life needs such as reading, working or moving around independently, not just numbers on an eye chart.

Before Surgery: Laying the Groundwork

The guidance stresses that good outcomes start well before the operating room. Every patient should receive a full medical and eye examination. Doctors must check for other eye diseases and health conditions, such as diabetes or high blood pressure, that could affect surgery.

Accurate measurements of the eye are essential to choose the correct intraocular lens. Equipment must be well-maintained and properly calibrated. Patients should also be given clear information about the procedure, anaesthesia options and possible complications. Consent forms should be written in simple language, and interpreters should be used when needed.

Special attention is required when planning surgery for the second eye. While it is common to wait at least a week between operations to monitor for complications, in some situations, both eyes may be operated on the same day, provided strict infection control standards are in place.

Inside the Operating Theatre: Safety First

During surgery, safety systems are critical. Operating theatres must follow strict sterilization procedures. Staff should be properly trained, and infection prevention must be a top priority.

A simple but powerful step is the use of a surgical safety checklist to confirm the patient's identity, the correct eye and the selected lens before surgery begins. This reduces the risk of avoidable errors.

Different surgical techniques are acceptable, including phacoemulsification, small-incision cataract surgery and extracapsular extraction. The choice depends on the patient's condition, the surgeon's skills and available resources. In many lower-resource settings, small-incision surgery remains widely used because it is effective, safe and less dependent on expensive equipment.

The routine use of intracameral antibiotics during surgery is strongly recommended to prevent serious infections such as endophthalmitis.

After Surgery: Monitoring and Measuring Success

Postoperative care is just as important as the operation itself. Patients should receive antibiotic and anti-inflammatory eye drops as needed. Follow-up visits are essential. Most patients should be checked within 24 to 48 hours after surgery, again at one week and later at four to six weeks to assess healing and vision.

Monitoring outcomes is central to improving services. WHO recommends that at least 80 percent of patients should achieve good vision, defined as 6/12 or better, within four to 12 weeks after surgery. Facilities should track their results and review complication rates regularly.

Patient feedback also matters. Satisfaction surveys and patient-reported outcome measures help ensure that services are truly improving people's lives.

The message of the new guidance is clear: cataract surgery is one of the most cost-effective and life-changing medical procedures available. But expanding access must go hand in hand with improving quality. By strengthening systems, training health workers and focusing on patient-centred care, countries can ensure that millions more people not only undergo surgery but truly regain their sight and independence.